Abstract:
The development of status myoclonus (SM) in a post-cardiac arrest patient has historically been thought of as indicative of not only a poor neurologic outcome but of neurologic devastation. In many instances, this may lead clinicians to initiate conversations about withdrawal of life sustaining therapies (WLST) regardless of the time from return of spontaneous circulation (ROSC). Recent studies showing a percentage of patients may make a good recovery has called into question whether a self-fulfilling prophecy has developed where the concern for a poor neurologic outcome leads clinicians to prematurely discuss WLST. The issue is only further complicated by changing terminology, lack of neuro-axis localization, and limited data regarding association with electroencephalogram (EEG) characteristics, all of which could aid in the understanding of the severity of neurologic injury associated with SM. Here we review the initial literature reporting SM as indicative of poor neurologic outcome, the studies that call this into question, the various definitions of SM and related terms as well as data regarding association with EEG backgrounds. We propose that improved prognostication on outcomes results from combining the presence of SM with other clinical variables (eg. EEG patterns, MRI findings, clinical exam). We discuss the ethical implications of using SM as a prognostic tool and its impact on decisions about life-sustaining care in children following cardiac arrest. We advocate for prognostication efforts to be delayed for at least 72 hours following ROSC and thus to treat SM in those early hours and days.
Biography:
Dr. Alyson Baker received her medical degree from Saint Louis University School of Medicine in St Louis, Missouri. She completed her pediatric residency at Connecticut Children’s Medical Center at University of Connecticut, pediatric critical care fellowship at Riley Hospital for Children at Indiana University and pediatric neurocritical care fellowship at St Louis Children’s Hospital at Washington University in St Louis MO. She is an assistant professor of Pediatrics in Pediatric Critical Care at UNMC College of Medicine. Dr. Baker’s clinical interests include treating all critically ill children, but has a passion for those with neurocritical conditions including such conditions as status epilepticus, stroke and traumatic brain injury.
Alyson Baker
